198004153-10-10-2019-33-CC-CGRN-BGTRLR-20191010130734

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198004153
Report Date: 10/10/2019
Date Signed: 10/10/2019 01:07:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME:	WOODBURY VILLAGE, INC.		FACILITY NUMBER:	198004153
ADMINISTRATOR:	DANIELLE SVIHOVEC-MESQUITA		FACILITY TYPE:	850
ADDRESS:	712 W. MT. VIEW ST.		TELEPHONE:	(626) 794-3211
CITY:	ALTADENA	STATE: CA	ZIP CODE:	91001
CAPACITY:	61	CENSUS: 30	DATE:	10/10/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	12:01 PM
MET WITH:	Danielle Svihovec- Mesquita		TIME COMPLETED:	01:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Crystal Green conducted an unannounced annual/random inspection. Upon arrival, LPA met with Danielle Svihovec- Mesquita, Director. LPA was guided on a tour of the facility. The preschool program licensed for (61) preschoolers. There is also an Infant Center located on the same premises (#198004154), which was observed to be physically separated from the preschool center both indoors and outdoors. This Preschool program consists of 4 classrooms (Jags, Tigers, Bears and Cubs). LPA observed in the Jags classroom to have (19) preschoolers with (2) staff members. In the Tigers classroom, LPA observed (12) napping preschoolers with (5) staff members. In the Bears and Cubs classroom, LPA observed (18) napping preschoolers with (3) staff members. All preschoolers were observed by LPA to be under visual supervision of a teacher at all times. The Licensee is within the conditions, limitations, and capacity specified on the license. The facility was observed to be meeting the required teacher-child ratio. Sign in and out sheets was reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day. Furniture and equipment are in good condition, free of sharp, loose, or pointed parts. Disinfectants, cleaning solutions, medication and other items that are dangerous to children, were inaccessible. All toilets, hand washing stations are safe, sanitary and in operable condition. All floors are clean and safe. There is drinking water available in each classroom via sippy cups and water dispenser. At this time, the Director's Office is used as an isolation area. A sofa chair is available for ill infants to rest until parent arrives. Outdoor playground equipment is in good condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe and is free of hazards. All areas around or under climbing equipment and similar equipment cushioned with material to absorbs a fall. There is adequate shade provided in the play yard. There are operational drinking fountains available outdoors so that the children may drink freely.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: WOODBURY VILLAGE, INC.	FACILITY NUMBER: 198004153
	VISIT DATE: 10/10/2019

NARRATIVE

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Food storage areas are kept clean and are free of litter, rubbish and rodents and/or any other vermin. All storage containers for solid waste, including moveable bins shall have tight-fitting covers that are kept on, and in good repair. Menu is posted and available for review. Snacks and meals are eaten in the classroom family style.
Staff Records was reviewed to ensure that each file contains a Personnel Record, Qualifications and verification of CPR/First Aid and health preventative practices documentation. Children’s Records was reviewed to ensure that each child has an Emergency and Identification form on file. Staff and children's records were reviewed and deemed qualified.

This facility already offers Incidental Medial Services (IMS) to children that require it. Policy for IMS services already on file per Director.

No deficiencies are being cited in accordance with California Code of Regulations Title 22.

Exit interview was conducted with Director, including, but not limited to Provider Rights, Appeal Procedures and Agencies Consultative Role.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

SUPERVISOR'S NAME: Christina Gabelman	TELEPHONE: (323) 854-8930
LICENSING EVALUATOR NAME: Crystal Green	TELEPHONE: (323) 980-4930
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2019

LIC809 (FAS) - (06/04)

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